Prevention and Management of Gastroesophageal Varices in Cirrhosis

Table 2

Initial medical management of acute variceal bleeding.

Treatment	Dose	Duration	Details
Antibiotics
Ceftriaxone	1 g IV daily	5–7 days	Severe cirrhosis Child B/C and/or high suspicion of quinolone resistance
Ciprofloxacin	400 mg IV or 500 mg oral twice daily	5–7 days	Mild cirrhosis Child A and low suspicion of quinolone resistance
Norfloxacin	400 mg oral twice daily	5–7days	Mild cirrhosis Child A and low suspicion of quinolone resistance
Vasoconstrictors
Octreotide	50 μg IV bolus, then infusion at 50 μg/hr	2–5 days	Initial bolus can be repeated in the first hour if bleed not controlled
Terlipressin	2 mg IV every 4 hr × 48 hr, then 1 mg IV every 4 hr	2–5 days	Not available in North America
Somatostatin	250 μg IV bolus, then 250–500 μg/hr	2–5 days	Not available in North America